General Surgery Coding Alert

Question: A patient is assigned to a hospitalist group for observation admission. 'The emergency department physician notifies the hospitalist on call of the admission. The ED physician writes the admission orders, and the patient is admitted around 10 p.m.

Arizona Subscriber

Answer: Coding guidelines stipulate that you should report 99218-99220 (Initial observation care, per day, for the evaluation and management of a patient) with 99217 (Observation care discharge day management) if the same physician admits the patient to observation and releases her on a different date of service, unless the total duration of the observation stay equals fewer than eight hours.

In this case, the visit does last longer than eight hours, but you can't bill for the admission date before midnight because the patient wasn't actually seen by the physician you are billing for.

You also shouldn't report observation/inpatient hospital care E/M codes 99234-99236 (Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date) because these codes assume the same physician admits and discharges the patient -- which is not the case here.

In this case, you-re probably best simply to report a discharge service, 99217. The admitting (ED) physician would report 99218-99220 separately for the observation admission on a different service date, more than eight hours prior to discharge.